Linked police and health data: a step closer to effective domestic abuse prevention
Authors: Illin Gani, Joht Singh Chandan
Journal: The Lancet Public Health (2023)

Domestic abuse is estimated to affect one in three women globally and one in five adults (aged older than 16 years) in the UK in their lifetime.1Office for National StatisticsDomestic abuse in England and Wales overview: November 2022.https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/domesticabuseinenglandandwalesoverview/november2022Date: Nov 25, 2022Date accessed: March 25, 2023Google Scholar Domestic abuse is fundamentally a human rights travesty, whereby people exposed to domestic abuse are not only traumatised because of the initial incident but they also often live with long-term health issues, which can be physical, sexual, and reproductive, as well as mental ill health.2Chandan JS Thomas T Bradbury-Jones C et al.Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness.Br J Psychiatry. 2020; 217: 562-567Crossref PubMed Scopus (62) Google Scholar, 3Chandan JS Thomas T Bradbury-Jones C Taylor J Bandyopadhyay S Nirantharakumar K Risk of cardiometabolic disease and all-cause mortality in female survivors of domestic abuse.J Am Heart Assoc. 2020; 9e014580 Crossref Scopus (42) Google Scholar, 4Chandan JS Keerthy D Gokhale KM et al.The association between exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitization: a retrospective cohort study using UK primary care records.Eur J Pain. 2021; 25: 1283-1291Crossref PubMed Scopus (10) Google Scholar, 5Bacchus LJ Ranganathan M Watts C Devries K Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies.BMJ Open. 2018; 8e019995 Crossref PubMed Scopus (174) Google Scholar As noted by the ongoing Lancet Commission on Gender-based Violence and Maltreatment of Young People, the effects of domestic abuse do not only affect the individual, but can also affect whole societies and economies—namely, they place demands on overstretched health systems and perpetuate gender inequality by constraining the educational attainment and economic productivity of the survivor and their family. There are few risk factors to health, wellbeing, a sense of life, and a productive community that are as damaging as domestic abuse. Hence, there is a crucial need for a commitment from policy makers to adopt a multi-system, multi-faceted public health approach to preventing domestic abuse.6Chandan JS Taylor J Bradbury-Jones C Nirantharakumar K Kane E Bandyopadhyay S COVID-19: a public health approach to manage domestic violence is needed.Lancet Public Health. 2020; 5: e309Summary Full Text Full Text PDF PubMed Scopus (128) Google Scholar Such an approach will require improved efforts to understand the problem (through better surveillance), the systematic identification of risk and protective factors (through epidemiological evidence), developing and evaluating interventions (including primary, secondary, and tertiary preventative measures), and the implementation of the interventions deemed effective.6Chandan JS Taylor J Bradbury-Jones C Nirantharakumar K Kane E Bandyopadhyay S COVID-19: a public health approach to manage domestic violence is needed.Lancet Public Health. 2020; 5: e309Summary Full Text Full Text PDF PubMed Scopus (128) Google Scholar Despite numerous calls to adopt such a strategy, globally researchers, practitioners, and service providers have faced challenges in optimising the current approach to domestic abuse prevention. For example, related to the enhancement of surveillance measures, often researchers and practitioners have to rely on non-linked data sources (eg, looking at police, hotline, health care, survey, and cohort data in unison) due to their anonymised nature.7Chandan JS Improving global surveillance of gender-based violence.Lancet. 2020; 3961562 Summary Full Text Full Text PDF Scopus (6) Google Scholar Solely relying on these measures as surveillance tools or for epidemiological purposes results in limitations including selection bias, confounding (such as the inability to adjust for seasonal variation), and having incomplete information on the sociodemographic data of those affected by domestic abuse or perpetrators. Additionally, examining domestic abuse through a single lens as captured by a single data source could lead to a substantial underestimation of the true burden and limit capturing the role of the services at play, meaning that interventions developed through this approach might not be generalisable or will support only a proportion of survivors, potentially further generating inequities. However, there are numerous logistic and technical challenges to linking data among public sector organisations in a manner that is safe, legal, ethically appropriate and publicly acceptable.8Harron K Data linkage in medical research.BMJ Med. 2022; 1e000087 Crossref Google Scholar Hence, we welcome the novel research undertaken by Natasha Kennedy and colleagues.9Kennedy N Win TL Bandyopadhyay A et al.Insights from linking police domestic abuse data and health data in South Wales, UK: a linked routine data analysis using decision tree classification.Lancet Public Health. 2023; 8: e629-e638Google Scholar In this Article, Kennedy and colleagues9Kennedy N Win TL Bandyopadhyay A et al.Insights from linking police domestic abuse data and health data in South Wales, UK: a linked routine data analysis using decision tree classification.Lancet Public Health. 2023; 8: e629-e638Google Scholar show how, through the linkage of police and health-care datasets in south Wales, they were able to identify that highly vulnerable individuals frequently interact with health-care services but are unknown to the police until a critical incident occurs. Therefore, using a linked data approach, the research team were able to identify opportunities for early intervention that could prevent future incidents of domestic abuse and severe health outcomes. The benefits of overcoming data linkage challenges have been made apparent throughout the COVID-19 pandemic. For example, during the pandemic, early efforts to take effective public health action were hampered by UK public bodies not sharing data, while sharing and linking data was found to improve identifying risk factors and treatment options.10The Lancet Digital HealthThe importance of linkage: lessons from one pandemic to another.Lancet Digit Health. 2022; 4: e698Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar In 2023, the pandemic of violence against women (including those affected by domestic abuse) is still raging, any further inaction to promote data linkage methods and support the integration of public sector electronic systems (such as a police and health-care data) is a missed opportunity. Moreover, the integration of such datasets will provide novel opportunities to tackle other overlapping health and social care issues. Hence, we commend the efforts by Kennedy and colleagues9Kennedy N Win TL Bandyopadhyay A et al.Insights from linking police domestic abuse data and health data in South Wales, UK: a linked routine data analysis using decision tree classification.Lancet Public Health. 2023; 8: e629-e638Google Scholar and recommend that others working in this field look to this study as a schematic for safe data linkage and, where suitable, attempt to apply this approach in other areas to provide a voice to the hidden victims in communities. JSC has received grants and fellowship funding from the National Institute for Health and Care Research, Youth Endowment Fund, and College of Policing, University of Birmingham & Birmingham City Council; and a travel grant from the University of Miami as part of the Lancet Commission on Gender-Based Violence and maltreatment of young people. Insights from linking police domestic abuse data and health data in South Wales, UK: a linked routine data analysis using decision tree classificationThe results indicate that vulnerable individuals are detectable in multiple datasets before and after involvement of the police. Operationalising these findings could reduce police callouts and future Emergency Department or hospital admissions, and improve outcomes for those who are vulnerable. Strategies include querying previous Emergency Department and hospital admissions, giving a high-risk assessment for a pregnant victim, and facilitating data linkage to identify vulnerable individuals. Full-Text PDF Open Access